Provider Demographics
NPI:1740550029
Name:THOMAS, DEIDRA OVERSTREET (RPH)
Entity type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:OVERSTREET
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 DUNBAR CT
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2121
Mailing Address - Country:US
Mailing Address - Phone:334-546-8563
Mailing Address - Fax:
Practice Address - Street 1:2640 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-1511
Practice Address - Country:US
Practice Address - Phone:334-745-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist